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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An inquiry based on statistical data concerning rheumatic diseases in seven European countries was performed. The data reported were based on the ICD (8th revision, 1965). The time of reference was the period 1968-78. The countries concerned (Czechoslovakia, Finland, France, the GDR, Poland, Sweden and the United Kingdom) reported data on the following 'measures of frequency': rates of hospital discharge; rates of spells of sickness and incapacity for work; incidences of disability pension due to rheumatic disorders. The main results are threefold: The social importance of rheumatic diseases has been increasing in several European countries in the late 1960s and 1970s, though the situation differs from one country to another. There is sufficient evidence to assume a true increase in the occurrence of clinical symptoms among persons afflicted with 'degenerative arthropathy', i.e. osteoarthrosis and vertebrogenic pain. The increasing social importance of 'degenerative arthropathy' ought to stimulate a process of rethinking of the traditionally established priorities in rheumatological research and practice.
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PMID:Medium-term trends in the occurrence of rheumatic diseases in European countries. Results of an inquiry on statistical data. 294 16

198 healthy, regularly menstruating women between 18-38 years of age volunteered for this study designed to evaluate a new type of levonorgestrel-releasing intracervical contraceptive device (LNG-ICD) which releases 20 mcg levonorgestrel/day. The insertion of the ICD occurred within 7 days of menstruation. Followup visits were 3 and 12 months following insertion. Subjects were asked to make additional visits if they experienced any problems with the ICD. Bimanual examination was performed, and blood pressure and body weight were measured at every visit. During the 12-month visit, a cervicovaginal smear was obtained. Life-table analysis of pregnancy and discontinuation rates were carried out according to the method of Potter. The observation period covered 1957 woman-months. The insertion of the ICD was considered to be easy by the majority of participants and by the doctor. No or minimal pain was felt by 56% and severe pain by 6% of the women. In 10% of the cases, the doctor considered the insertion to be difficult. In most of these cases, the internal os of the cervical canal was so tight that insertion was not possible without dilatation up to Hegar 4. 7 pregnancies occurred during this observation period, a net rate of 3.5. 6 of these 7 pregnancies occurred after an unnoticed expulsion of the device. 16 expulsions or partial expulsions occurred during the observation period. The primary reasons for termination were bleeding problems (4.6%), hormonal side effects (4.6%, and other medical reasons (2.6%). There was no termination because of amenorrhea. Additional reasons for termination were pain (2 subjects) and planning pregnancy (2 subjects). In 3 cases the ICD was removed because of an infection. No major changes in blood pressure were observed after 1 year of use of ICD. Cervicovaginal smears did not reveal any malignant or premalignant changes.
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PMID:Clinical performance of a levonorgestrel-releasing intracervical contraceptive device during the first year of use. 312 29

The multicenter study with the research criteria in the field of psychotherapy/psychosomatic medicine considered nine cases. One patient with cardiac neurosis (F45.3) and one patient with a persistent somatoform pain disorder (F54.4) were diagnosed in category F45.x. The rater agreement was 63-68%. 54% of the correct diagnoses made for three cases of colitis ulcerosa and Crohn's disease concurred (28%, 50%, and 80%). The case of anorexia nervosa (F50.0) was coded correctly by all of the raters, while the agreement for bulimia (F50.2) was 82%. Only 50% of the raters correctly assigned the dissociative disorder (F44.4). The agreement achieved for factitious disorder (F68.1) was 54%. Across all the psychosomatic disorders in ICD-10 there was an agreement of 65%. This result is markedly lower than the overall agreement of the Research Criteria Study (78%). Cardiac neurosis and bulimia were given a favorable prognosis. A more reticent psychotherapeutic commitment was seen for the classical psychosomatic disorders, persistent pain disorder, and factitious disorder. Anorexia nervosa and dissociative disorder assumed an intermediate position.
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PMID:Concepts of psychosomatic disorders in ICD-10: results of the Research Criteria Study. 776 55

Osteoid osteoma (ICD: 9191/0) and osteoblastoma (ICD: 9200/0) are closely related entities of osteoblastic-type tumors. Osteoid osteoma is a small benign (lesion 1-2 cm or less) neoplasm that is richly vascularized. Nerve fibers within the tissue surrounding the nidus lead to the characteristic pain. A typical finding is the perifocal osseous reaction around the nidus. Osteoblastoma is a progressively growing lesion of a diameter larger than 2 cm; it is sometimes painful and is characterized by the absence of any reactive perifocal bone formation. For both tumors the treatment is complete surgical excision. If the nidus of the osteoid osteoma is removed, the patient will be free of pain. For the osteoblastoma the treatment depends on the stage and localization of the tumor. Forty-seven patients with osteoid osteoma and 10 patients with osteoblastoma have been treated in Heidelberg since 1980. The radiological investigations and surgical treatment are discussed.
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PMID:[Benign bone tumors in the growth years--osteoid osteoma and osteoblastoma]. 789 4

The need to document cost-benefit of comprehensive work rehabilitation services represents a critical requirement for its long-term viability as a treatment option for injured workers. One approach to improving cost-benefit is to identify patients who experience difficulty completing a rigorous goal-oriented treatment approach. This study examined a set of psychological, pain, perceived work environment, and patient expectation measures in order to determine whether such factors were associated with failure to complete rehabilitation. Patients (n = 168) presenting with low back pain who participated in a multidisciplinary work rehabilitation program (physical conditioning, work conditioning, work-related pain and stress management, ergonomic consultation, and vocational counseling) were categorized into 2 groups based upon whether they completed the 4 week, 5 day per week program (n = 84) or were discharged prior to program completion (n = 84). T tests were computed for return to work expectation, pain (average pain intensity, fear of re-injury), psychological measures (somatization, dysthymia), perceived work environment (work pressure, control, supervisor support), and disability (duration of work disability, physical disability, perceived disability) variables found in previous studies to affect successful rehabilitation and return to work. The discharged group was marked by lower return to work expectations, and heightened somatization, pain intensity, and perceived disability. In addition, this group was significantly younger and had been out of work longer. The groups did not differ on gender, marital status, ICD-9 diagnoses or perceived work environment. These findings indicate that patients displaying the pattern of low return to work expectations, heightened perceived disability, pain and somatic focus experience compliance problems in an intensive work rehabilitation program.(ABSTRACT TRUNCATED AT 250 WORDS)
Pain 1994 Apr
PMID:Factors associated with early discharge from a multidisciplinary work rehabilitation program for chronic low back pain. 806 99

To assess associations between informal caregivers' satisfaction with services delivered to their dying cancer patients and their perceptions of the duration of functional limitation and the duration of various symptoms experienced by these patients, a secondary analysis was conducted on a subsample of the Regional Study of Care for the Dying (RSCD). The RSCD is a retrospective interview survey of family members or others who knew about the last year of life of a random sample of people who died in 20 health districts in the UK in 1990. The subsample consisted of 1858 informal caregivers of people who died from cancer (ICD codes 140-208). More than half (52%) of informal caregivers were highly satisfied with community nurses, compared to 39% and 35% of those who reported high satisfaction with services provided by general practitioners and hospital doctors respectively. Informal caregivers of patients who died from a lymphatic or haematopoietic tissue cancer were more likely than others to report high satisfaction with hospital doctors (47%), while least satisfaction was reported by those who cared for patients who had a neoplasm of the genito-urinary or respiratory/intrathoracic organs (30%). The duration of pain was not significantly related to any of the satisfaction measures. The results suggest the need to take patient clinical characteristics into account in population-based evaluations of palliative care. They also indicate the need for more research to be carried out to assess the reasons behind the dissatisfaction of informal caregivers of patients with respiratory or genito-urinary cancers with services provided by hospital doctors and to detect whether these patients have unmet needs that should be addressed. More research is also needed into the management of symptoms by the general practitioners, especially symptoms pertaining to respiration and incontinence.
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PMID:The effects of the clinical characteristics of dying cancer patients on informal caregivers' satisfaction with palliative care. 915 6

Assessing both physical and mental health is necessary in clinical settings to quantify the scope of disability and to evaluate the effectiveness of treatment programs. Changes in health-related quality of life following physical therapy treatment for many patients with orthopaedic-related diagnoses is not known. The purposes of this study were to describe changes in health-related quality of life between the initial assessment and the time of discharge from physical therapy for the most common orthopaedic diagnoses and to compare the patterns of deficit among diagnostic categories. Patient outcomes in this study were evaluated from a large database generated by the Focus on Therapeutic Outcomes (FOTO) network. Health-related and employment outcomes were described for adult patients who were classified using ICD-9-CM codes. The most common orthopaedic diagnostic categories were sacroiliac sprain, back sprain, low back pain (radiating and nonradiating), neck sprain, neck pain (radiating and nonradiating), adhesive capsulitis of the shoulder, rotator cuff injury, shoulder sprain, knee dislocation, knee sprain, and knee derangement. The primary outcome measure was a 17-item questionnaire (the MOS-17) derived from the RAND 36-Item Health Survey (SF-36) and the 12-item Short Form Health Survey (SF-12). The comparison of each cohort to population norms was made by calculating a standard score on patient data adjusted for age and gender. An effect size was calculated to measure the change in health or employment status between the initial assessment and discharge from physical therapy. For all diagnostic categories, health-related quality of life with respect to norms and employment status showed a consistent pattern of improvement at the time of discharge compared with the initial assessment. There were only small changes in physical function for neck and shoulder diagnostic categories. Nearly all of the diagnostic categories had large reductions in bodily pain. The amount of clinical change in the physical components of health-related quality of life--especially the physical function and role physical domains--differed substantially across specific diagnostic categories. The largest improvements in the physical function occurred for patients with knee dislocation and knee sprain. Patients with knee dislocation also had the largest improvement in role limitations due to physical problems. The design of this study does not permit conclusions about the efficacy of physical therapy. Further study is needed to determine if the finding of different levels of health status improvement across diagnostic categories was due to the nature of the outcome measure, the type of treatments given to each patient, or other confounding variables, like depression or preinjury functional level.
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PMID:Physical therapy and health-related outcomes for patients with common orthopaedic diagnoses. 951 68

A sample of 855 rural adult inhabitants of Udmurtia was interviewed by means of the Composite International Diagnostic Interview (CIDI) in order to investigate the incidence and prevalence of mood disorders. Depression affected 30.5% of the population according to ICD-10, and 22% according to DSM-III-R over a 12-month period. Depressive disorders were more common in women (40.5%) than in men (17.4%), and in subjects who were widowed (68.8%), divorced (55.6%) or had poor family relationships. Depression was not related to ethnicity, educational level, income or living conditions. Depression showed a high level of comorbidity with social phobia in Udmurts and with persistent somatoform pain disorder in Russian women. The annual incidence of depressive episode was 7.5%, and the highest risk of depression was among younger women and older men.
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PMID:Prevalence of mood disorders in the rural population of Udmurtia. 954 3

In victims of blunt abdominal trauma, the spleen is the most common organ damaged, it is the most likely source of serious injury, and is associated with significant morbidity and mortality. The participants in this study were emergency department (ED) patients with splenic trauma determined via imaging study, surgical exploration, or autopsy. Patients were located using both the institution's trauma registry and discharge diagnoses (ICD-9 codes) involving splenic injury resulting from blunt trauma. Medical records including pre-hospital, ED, and hospital information were reviewed. Chi Square and Fisher's exact test were used for statistical analysis where appropriate, with a P value of less than 0.05 considered significant. Fifty-five patients (60% male) were analyzed with a mean age of 31 years (range, 1 to 78 years). Sixteen (30%) patients (mean age 44 years) were managed operatively, with 14 patients receiving only a diagnostic peritoneal lavage. All 38 patients (70%, mean age 26 years) who received nonoperative management were diagnosed by computed tomography. The motor vehicle crash represented the most frequent mechanism of injury in both groups; the nonoperative group, however, experienced other injury mechanisms more frequently. Clinical variables suggestive of the need for urgent surgical intervention (from ED to the surgical suite) include hypotension (systolic blood pressure less than 90 mm/Hg) in the pre-hospital setting or ED; tachycardia (heart rate greater than 100 beats/min) in the ED; abnormal hematocrit (less than 30) or coagulopathy (prothrombin time greater than 14 seconds) in the ED; multiple injuries; or blood transfusion in the ED. Complaints of pain resulting from traumatic injury and abdominal examination findings did not identify patients requiring urgent operative management. Hemodynamic instability, evidence of multiple injuries, abnormal laboratory parameters, and the requirement for blood transfusion in the ED identifies a patient population likely to require operative therapy of their splenic injury. Emergency physicians should consider early surgical consultation or urgent transfer to the regional trauma center in patients with these characteristics.
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PMID:Blunt splenic trauma: characteristics of patients requiring urgent laparotomy. 958 83

To compare medical records of patients treated for acute low back pain in the departments of Family Medicine, Internal Medicine, Occupational Medicine and Emergency Medicine in an academic medical center to determine if there was variation in patient population, diagnostic and treatment procedures and outcomes. Records were randomly reviewed using a standardized form for patients diagnosed with ICD 9 codes pertaining to back pain. Of the 96 patients with acute back pain seen in outpatient areas, 66 were seen by Family Medicine, 26 by Medical Group Practice (MGP), and four by Occupational Medicine. One hundred seven were seen in the Emergency Department. There was no significant difference in duration or type of pain or the type of findings or treatment. Very few had positive physical findings, (9% outpatient and 10% Emergency Department), but many more, (38% outpatient and 17% ED), had psychosocial findings (smoker, dissatisfaction with work, previous psychiatric history, psychosomatic history, or abnormal social adjustment) documented, Plain films of the lumbrosacral spine done in both practice settings did not change treatment.
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PMID:Acute low back pain findings and management in an academic medical center. 973 86


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